Association Between Body Mass Index, Body Shape Perception and Depression in Korean Female Population: The Korean National Health and Nutrition Examination Survey / 생물치료정신의학

Objectives@#The purpose of this study was to investigate the association between body mass index (BMI) and body shape perception and depression. @*Methods@#This study was based on data from 2016, 2018, and 2020 Korean National Health and Nutrition Examination Survey (KNHANES). The subjects were 7,302 adult female aged 19 to 65. We performed chi-square test with the RaoScott correction and Logistic regression analyses to examine the association among BMI, body shape perception, and depression. @*Results@#All demographic variables such as age, household income, education, marital status, medical service satisfaction, body shape perception, medical conditions except drinking problem, smoking and physical activity were correlated with depression. The rate of depression decreased from underweight to normal weight and overweight, and increased from obesity to severe obesity (p<0.001). And people who perceived themselves thin or overweight had more depression than normal (p<0.001). @*Conclusions@#The results of this study suggest that appropriate body mass index and normal body shape perception have a positive effect on mental health.

A Study of Factors Associated with Depression and Sleep Time Among the Aged 65 Years or Older: Analysis Based on the Seventh Korean National Health and Nutrition Examination Survey / 생물치료정신의학

Objectives@#：We investigated relationship between sleep time and depression in the aged 65 years or older. @*Methods@#：This study was based on the data from seventh Korean National Health and Nutrition Examination Survey (KNHANES). 3,285 people aged 65 years or older were selected as the subjects of this research. The demographic characteristics, sleep time and Patient Health Questinnaire-9 (PHQ-9) were administered for each subjects. Depression was defined as above 10 points of PHQ-9. @*Results@#：All the demographic variables such as age, sex, education, household income, marital status, drinking and smoking except Body Mass Index (BMI) were correlated with the depression. When we corrected the variables, inadequate sleep time groups (less than 6 hours or more than 9 hours) tended to be depressed. @*Conclusions@#：The study results showed the significant correlation between sleep time and depression in the aged 65 years or older. Adequate sleep time is important to prevent the depression of the aged.

The Comparison of Prevalence and Patterns of Sexual Dysfunction between Patients with Schizophrenia and Healthy Controls / 생물치료정신의학

Objectives@#：Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. @*Methods@#：Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. @*Results@#：The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. @*Conclusion@#：The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.

The Comparison of Prevalence and Patterns of Sexual Dysfunction between Patients with Schizophrenia and Healthy Controls / 생물치료정신의학

Objectives@#：Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. @*Methods@#：Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. @*Results@#：The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. @*Conclusion@#：The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.

What Physical Activities Can Help You Feel Better?: Analysis Based on the 2016 Korean National Health and Nutrition Examination Survey / 우울ㆍ조울병

Background@#This study aimed to investigate the relationship between exercise and depression based on responses to 2016 Korean National Health and Nutrition Examination Survey (KNHANES) and the Patient Health Questionairre-9 (PHQ-9). Specifically, this study examined which physical activities have the greatest effects in combating depression. @*Methods@#This study was based on data from 2016 KNHANES and responses to the PHQ-9 questionnaire on physical activity. We selected 2,245 people of age >19 years, who completed the surveys. Physical activity variables included number of days of walking, duration of walking, days of strength training, and aerobic physical activity. These variables subdivided into aerobic and muscle strengthening activities and their effects on depression were examined. @*Results@#All the variables, except duration of walking, were negatively correlated with the PHQ-9 scale scores. However, of the physical activity variables included in the hierarchical regression analysis, only the number of days of walking over 1 week had a statistically significant negative effect on the PHQ-9 scores. @*Conclusion@#For adults, aerobic activity (walking) had a greater effect on reducing depression than muscle strengthening activity. The frequency and consistency of walking had a greater impact than the duration of walks. These results suggest that regular walking is a better form of physical activity than strength training for its effect on mood and it assists in overcoming depression.

Switching Antipsychotics to Blonanserin in Patients with Schizophrenia: An Open-label, Prospective, Multicenter Study

OBJECTIVE: This study was performed to investigate the efficacy and tolerability of blonanserin in schizophrenic patients who were previously treated with other antipsychotics but, due to insufficient response, were switched to blonanserin. METHODS: A total of 52 patients with schizophrenia who were unresponsive to treatment with antipsychotic monotherapy or combination therapy were recruited into this 12-week, open-label, prospective, multicenter study. Patients were switched to blonanserin from their existing antipsychotics over a maximum 2-week tapering-off period. Efficacy was primarily evaluated using the 18-item Brief Psychiatric Rating Scale (BPRS). Assessments were performed at baseline, and at weeks 1, 2, 4, 8, and 12. RESULTS: Switching to blonanserin resulted in a significant decrease in the mean total score on the BPRS from baseline (56.8 ± 9.4) to week 12 (42.1 ± 13.8, p < 0.001). The most common adverse events were extrapyramidal symptoms (n = 12, 23.1%), insomnia (n = 10, 19.2%), and emotional arousal (n = 6, 11.5%). Overweight or obese patients (body mass index ≥ 23 kg/m2, n = 33) who switched to blonanserin exhibited significant weight loss from 75.2 ± 9.3 kg at baseline to 73.5 ± 9.2 kg at week 12 (p = 0.006). The total cholesterol (baseline, 236.1 ± 47.6 mg/dl; endpoint [week 12], 209.9 ± 28.0 mg/dl; p = 0.005) and prolactin levels (baseline, 80.0 ± 85.2 ng/ml; endpoint [week 12], 63.2 ± 88.9 ng/ml; p = 0.003) were also significantly improved in patients with hypercholesterolemia or hyperprolactinemia. CONCLUSION: The results of the present study suggest that switching to blonanserin may be an effective strategy for schizophrenic patients unresponsive to other antipsychotic treatments.

Comparison of Psychological Characteristics of Lesch Types 2 (Anxiety Model) and 3 (Depressive Model) Alcoholism / 우울ㆍ조울병

BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.

A Study of Factors Influencing Subjective Memory Complaints among Community Dwelling Elderly

OBJECTIVE: We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. METHODS: The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. RESULTS: 39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p < 0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). CONCLUSION: There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.

Times to Discontinue Antidepressants Over 6 Months in Patients with Major Depressive Disorder

OBJECTIVE: The aim of the present study was to investigate differences in discontinuation time among antidepressants and total antidepressant discontinuation rate of patients with depression over a 6 month period in a naturalistic treatment setting. METHODS: We reviewed the medical records of 900 patients with major depressive disorder who were initially prescribed only one kind of antidepressant. The prescribed antidepressants and the reasons for discontinuation were surveyed at baseline and every 4 weeks during the 24 week study. We investigated the discontinuation rate and the mean time to discontinuation among six antidepressants groups. RESULTS: Mean and median overall discontinuation times were 13.8 and 12 weeks, respectively. Sertraline and escitalopram had longer discontinuation times than that of fluoxetine, and patients who used sertraline discontinued use significantly later than those taking mirtazapine. No differences in discontinuation rate were observed after 24 weeks among these antidepressants. About 73% of patients discontinued antidepressant treatment after 24 weeks. CONCLUSION: Sertraline and escitalopram tended to have longer mean times to discontinuation, although no difference in discontinuation rate was detected between antidepressants after 24 weeks. About three-quarters of patients discontinued antidepressant maintenance therapy after 24 weeks.

Bradykinesia, Rigidity and Gait Disturbance Due to "Possible" Normal Pressure Hydrocephalus in a Patient with Anxiety and Bipolar Disorder : A Case Report / 정신신체의학

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.

The Effect of a 12-week Weight Management Program on the Quality of Life in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: This study was designed to examine the effect of a 12-week weight management program on the quality of life, self-esteem and psychotic symptoms of schizophrenia. METHODS: The subjects of the experiment consisted of psychiatric patients taking antipsychotics who were diagnosed with DSM-IV schizophrenia. The experimental group were patients with body mass index of 25 kg/m2 or above who participated in a 12-week weight management program, while the control group did not join the program. All the patients were admitted in closed psychiatry ward of a mental hospital. The program consisted of diet therapy, exercise, behavior modification and education. All the patients were checked on Brief Psychiatric Rating Scale (BPRS), Rosenberg Self-esteem Scale (RSES), Korean version of the SmithKlein Beecham Quality of Life (KvSBQOL), Korean version of 4th revision of Schizophrenia Quality of Life Scale (SQLS-R4K) and the weight. RESULTS: After the 12-week weight management program, RSES, KvSBQOL and SQLS-R4K were increased significantly in the experimental group (p<0.001), as opposed to the control group. While the experimental group showed a notable increase in body weight and body mass index (BMI), the change in the control group was insignificant. BPRS was decreased significantly (p<0.05). CONCLUSION: 12-week weight management program had a positive effect to decrease the weight and to increase the self-esteem and quality of life. This study provides evidence for the potential and beneficial effect of weight management program for schizophrenic patients.

The Effect of a 12-week Weight Management Program on the Quality of Life in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: This study was designed to examine the effect of a 12-week weight management program on the quality of life, self-esteem and psychotic symptoms of schizophrenia. METHODS: The subjects of the experiment consisted of psychiatric patients taking antipsychotics who were diagnosed with DSM-IV schizophrenia. The experimental group were patients with body mass index of 25 kg/m2 or above who participated in a 12-week weight management program, while the control group did not join the program. All the patients were admitted in closed psychiatry ward of a mental hospital. The program consisted of diet therapy, exercise, behavior modification and education. All the patients were checked on Brief Psychiatric Rating Scale (BPRS), Rosenberg Self-esteem Scale (RSES), Korean version of the SmithKlein Beecham Quality of Life (KvSBQOL), Korean version of 4th revision of Schizophrenia Quality of Life Scale (SQLS-R4K) and the weight. RESULTS: After the 12-week weight management program, RSES, KvSBQOL and SQLS-R4K were increased significantly in the experimental group (p<0.001), as opposed to the control group. While the experimental group showed a notable increase in body weight and body mass index (BMI), the change in the control group was insignificant. BPRS was decreased significantly (p<0.05). CONCLUSION: 12-week weight management program had a positive effect to decrease the weight and to increase the self-esteem and quality of life. This study provides evidence for the potential and beneficial effect of weight management program for schizophrenic patients.

A Preliminary Study on Emotion, Self-Esteem and Quality of Life in the Patients with Chest Pain / 정신신체의학

OBJECTIVES: The objective of this study is to measure and to compare the rate of depression, anxiety, self-esteem and the quality of life of the patients with chest pain. Based on the result of this study, the necessity of the psychiatric assessment and treatment of the patients with chest pain is emphasized. This study is a preliminary research for a larger scale investigation to be carried out in the future. METHODS: Thirty nine patients with chest pain who visited Cardiovascular Division of Dept. of Internal Medicine Pusan National University Hospital and fourty normal control group(NC) were included in this study. The patients were classified into typical chest pain group(TCP, N=19) and atypical chest pain group(ACP, N=20) based on the cause of the pain. The cause was determined by cardiac computed tomography, exercise stress test, coronary angiography, and questionaires by a cardiology specialist. The patients were assessed with Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), Rosenberg Self-Esteem Scale(RSES) and Korean version of the Smith Klein Beecham 'Quality of Life' scale(KvSBQOL). RESULTS: 1) When the risk factors of cardiac disease is compared, most of the factors(Hypertension, Diabetes, Hyperlipidemia, Cerebral infarction) did not differ significantly among the two chest pain groups, except for the family history, for which TCP group showed higher risk than ACP group did. 2) As for the self-report questionaires scores, BDI score, which indicates the rate of depression, of both ACP group and TCP group was significantly higher than that of NC group in BDI for depression. STAI score, which measures anxiety, was also significantly high in both groups. Especially, STAI score was significantly higher in ACP group than TCP group. 3) In the aspect of self-esteem and quality of life, ACP group scored significantly lower than TCP group and NC group. The scores for TCP group and NC group did not differ significantly. CONCLUSIONS: The patients with chest pain showed more depression and anxiety than normal control group, regardless of the cause of the pain. However, TCP group did not show significantly larger drop in self-esteem and quality of life than ACP group did. This result implies that early psychiatric assessment and treatment is needed for the patients with such chest pain, since it is highly likely that the pain would lead to lower quality of life of the patients.

The Symptom Frequency Characteristics of the Hamilton Depression Rating Scale and Possible Symptom Clusters of Depressive Disorders in Korea: The CRESCEND Study

OBJECTIVE: This study analyzed the symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) to understand the characteristics of each item and to propose the possible symptoms clusters. METHODS: From psychiatric clinics of 18 Hospitals in Korea, 1,183 patients, diagnosed with major depressive disorder (psychotic or non-psychotic), dysthymia or depressive disorder not otherwise specified. according to DSM-IV criteria, participated in this study from January 2006 to August 2008. The frequencies of each item of HDRS-17 were analyzed according to sex and severity. In addition, we compared this study with a previous study performed in England by Hamilton and with two studies performed in Korea by Kim et al. RESULTS: The frequencies of HDRS-17 items varied widely in this study, ranging from 95.8% in work and activities to 37.4% in loss of weight. But, depressed mood, psychic anxiety and work and activities items exhibited constant and higher frequency or rank regardless of study, the severity of depression or sex. Insomnia early, somatic gastrointestinal, genital symptoms and insight showed relatively constant but lower frequency or rank in disregard of studies or the clinical variables. Other symptoms had variable frequencies or ranks according to the variable clinical situations (culture, time, sex, severity of depression). CONCLUSION: We propose three clusters of symptoms in depressive disorders: core symptoms cluster, an associated symptoms, and a situation-specific symptoms. We can use these possible symptom clusters of depression in simplifying diagnosis of depression, increasing diagnostic specificity in special situation and indexing disease severity.

A Case of Paroxetine-Related Hyperprolactinemia / 대한정신약물학회지

Although selective serotonin reuptake inhibitors (SSRIs) have been widely used in both psychiatry and other medicine, few cases have been reported SSRI-related hyperprolactinemia and/or galactorrhea. We experienced one case which showed both galactorrhea and hyperprolactinemia following treatment with paroxetine. In the case, a 37-year-old multiparous woman reported galactorrhea after 8-weeks paroxetine treatment for her depression. After 1 month prescription of bromocriptine, dopamine agonist, as well as switching medication from paroxetine to venlafaxine, serotonin-norepinephrine reuptake inhibitor, both galactorrhea and hyperprolactinemia were disappeared. Both hyperprolactinemia and galactorrhea have not been observed even after the cessation of bromocriptine prescription.

Non-Relapse Rate in a 24 Week Follow-up Clinical Study with Korean Male Alcohol-Dependent Patients / 신경정신의학

OBJECTIVES: In order to provide useful data for the further clinical studies with Korean alcohol-dependent patients, enrollment and non-relapse rates were investigated while alcohol-dependent patients were followed up for 24 weeks. METHODS: The subjects of this study were alcohol-dependent male patients who, for the first time, visited a hospital among 3 groups of hospitals, University Hospital, General Hospital or Mental Hospital, or those who needed to be followed up after discharge from those hospitals. After assigning 12 subjects to each hospital, we investigated enrollment and non-relapse rates while cognitive-behavioral therapy and pharmacotherapy were provided. RESULTS: 1) Forty-eight patients were enrolled and the rate of enrollment was 36.4%. The enrollment rate in the University Hospital group was 52.1%, in the General Hospital group 50.0%, and in the Mental Hospital group 10.4%. 2) In 48 patients, non-relapse rate was 27.1% at 12 week and 18.8% at 24 weeks after starting follow-up. It was 24.4% and 20.0% at 12 and 24 weeks, repectively, in the University Hospital group while the General Hospital group showed 33.3% and 16.7%, respectively, and the Mental Hospital Group showed 20.0% at both 12 and 24 weeks. CONCLUSION: These results provide important data for further clinical studies of Korean alcohol-dependent patients.